Optimizing a Level 1 Trauma Pediatric Emergency Department Tracking Board—A Quality Improvement Initiative

Background: Efficient monitoring of patient flow is essential to emergency department (ED) operations. Electronic tracking boards organize real-time clinical data but often display nonessential information. We evaluated whether optimizing an ED tracking board design was associated with improved throughput metrics in a pediatric ED. Methods: The ED tracking board was optimized by removing 8 nonpertinent columns and adding vital signs, bed status, floor orders, and unassigned patients ready to be seen. Primary outcomes were mean daily door-to-doc, room-to-doc, doc-to-disposition, and bed-to-admit times in the postintervention period compared with the preintervention period. Analyses were stratified by provider type and adjusted for ED volume, patient acuity, provider coverage, and month. Results: We analyzed 68,979 ED encounters from April 2022 to March 2024. Left without being seen (LWBS) rates decreased from 13.9% to 6.9% ( P <0.001). Among all providers, the postintervention period was associated with lower door-to-doc time (82.9 vs. 59.1 min), room-to-doc time (9.8 vs. 7.2 min), and total ED length of stay (318.9 vs. 296.5 min; all P <0.001). These improvements persisted after the adjusted analysis. There was no significant difference in doc-to-disposition or bed-to-admit times. Conclusions: Multiple factors influence ED throughput. In this pediatric ED, tracking board optimization was associated with significant reductions in door-to-doc time, room-to-doc time, LWBS rates, and total ED LOS across all provider types, persisting after adjustment for volume, acuity, provider coverage, and month. As tracking boards are used by all ED providers, their optimization represents a broadly applicable and low-cost target for throughput improvement.